低分子肝素应用于妊娠期羊水过少对产后胎盘的病理影响  

Impact of low molecular weight heparin treating oligohydramnios during pregnancy on postpartum placenta pathology

作　　者：彭惠芬 康高杨 彭莹 翟丽丽[2] Peng Huifen;Kang Gaoyang;Peng Ying;Zhai Lili(Department of Obstetrics,Qiqihar First Hospital,Qiqihar,Heilongjiang 161005,China;Department of Pathology,Qiqihar First Hospital,Qiqihar,Heilongjiang 161005,China)

机构地区：[1]齐齐哈尔市第一医院产科,黑龙江齐齐哈尔161005 [2]齐齐哈尔市第一医院病理科,黑龙江齐齐哈尔161005

出　　处：《齐齐哈尔医学院学报》2023年第21期2022-2026,共5页Journal of Qiqihar Medical University

基　　金：黑龙江省卫生健康委科研课题(20210505020010)。

摘　　要：目的 探讨低分子肝素应用于妊娠晚期临界性羊水过少的孕妇在免疫因素的影响下对胎盘的临床作用价值。方法 选择2022年1—12月本院收治的164例妊娠晚期临界性羊水过少的孕妇作为研究对象,按照其免疫指标结果分为免疫指标阳性者和免疫指标阴性者,其中免疫指标阳性者分为观察组Ⅰ和对照组Ⅰ,免疫指标阴性者分为观察组Ⅱ和对照组Ⅱ。对照组均采用水化疗法,观察组在对照组基础上联合应用低分子肝素。产后胎盘送病理,在显微镜下观察胎盘梗死灶范围及钙化区域(S),分为三个级别:胎盘梗死和/或散在钙化(S≤5%)、胎盘梗死和/或钙化(5%10%)。结果 观察组Ⅰ和对照组Ⅰ(免疫指标阳性者)产后胎盘梗死灶范围及钙化区域(S)的差异有统计学意义(P=0.0061);观察组Ⅱ和对照组Ⅱ(免疫指标阴性者)产后胎盘梗死灶范围及钙化区域(S)的差异有统计学意义(P=0.0092);观察组Ⅰ和观察组Ⅱ(采用低分子肝素治疗联合水化疗法)产后胎盘梗死灶范围及钙化区域(S)的差异没有统计学意义(P=1.0000)。结论 对于妊娠晚期临界性羊水过少的孕妇,不论免疫指标性质如何,应用低分子肝素后,产后的胎盘病理显示梗死灶范围和/或钙化区域较未应用低分子肝素的明显减小,说明应用低分子肝素后能通过影响母体凝血途径、调节胎盘细胞因子等途径改善胎盘循环功能,而羊水过少受多因素多通路影响,低分子肝素对胎盘和对免疫性疾病所致的羊水过少的影响有可能是通过不同的途径来起作用的。Objective To explore the clinical value of low molecular weight heparin to placentain in the treatment of critical oligohydramnios in late pregnancy under the influence of immune factors.Methods 164 pregnant women with critical oligohydramnios in late pregnancy,who were admitted to the hospital during January and December 2022 were collected as study subjects,and they were divided into immune positive and immune negative individuals based on their immune index results.Among them,immune positive individuals were divided into observation groupⅠand control groupⅠ,while immune negative individuals were divided into observation groupⅡand control groupⅡ.The control group received hydration therapy,while the observation group received a combination treatment of low molecular weight heparin on the basis of the control group.Postpartum placental pathology involved observing the extent of placental infarction and calcification area(S)under a microscope,which could be divided into three levels:placental infarction and/or scattered calcification(S≤5%),placental infarction and/or calcification(5%<S≤10%),and placental infarction and/or calcification(S>10%).Results There was a statistically significant difference in the range of postpartum placental infarction and calcification area(S)between observation groupⅠand control group I(those with positive immune indicators)(P=0.0061);There was a statistically significant difference in the range of postpartum placental infarction and calcification area(S)between observation groupⅡand control groupⅡ(those with negative immune indicators)(P=0.0092);There was no statistically significant difference between observation groupⅠand observation groupⅡ(using low molecular weight heparin therapy combined with hydration therapy)in the range of postpartum placental infarction and calcification area(S)(P=1.0000).Conclusions For pregnant women with critical oligohydramnios in late pregnancy,regardless of the nature of immune indicators,the postpartum placental pathology shows

关 键 词：低分子肝素 胎盘 病理 胎盘梗死 羊水过少 免疫因素 抗凝治疗 水化疗法 

分 类 号：R714.2[医药卫生—妇产科学]